Conference Summaries: ICAAC 2001, IDSA 2001, and ASTMH
Conference Summaries: ICAAC 2001, IDSA 2001, and ASTMH
Conference Coverage
Editor’s Note: The following summaries represent a selection of papers from those presented at the meetings listed below. It is important to recognize that many of these summaries are extracted only from the published abstract, and it is possible that some of the material presented at the conferences may have differed. The abstracts can be found online at the URLs given. The 41st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, Ill, Dec. 16-19, 2001; www.icaac.org. The 39th Annual Meeting of the Infectious Diseases Society of America, San Francisco, Calif, Oct. 25-28, 2001; http://www.idsociety.org. The 50th Annual Meeting of the American Society of Tropical Medicine and Hygiene, Atlanta, Ga, Nov. 11-15, 2001; www.astmh.org. — Stan Deresinski, MD, FACP
NOSOCOMIAL INFECTION AND HOSPITAL EPIDEMIOLOGY
Economics. The unreimbursed costs of a single outbreak of S marcescens infection involving 6 children in Zurich were of sufficient magnitude to have covered the salary of an infection control nurse for 6 years. (ICAAC #402.)
Strain Typing. A single clone of K pneumoniae that nonetheless exhibited 10 distinct antibiograms caused a nosocomial outbreak. The latter was the result of the differential presence of various integrons, a gyrA mutation combined with an efflux pump, and a SHV-5 gene. (ICAAC #70.)
Hands. The wearing of a finger ring was the major risk factor identified for hand carriage of many potential nosocomial pathogens on the hands of SICU nurses. (ICAAC #1333.) Health care workers with long fingernails (mean subungual length, > 3 mm) had increased likelihood of hand colonization with potential pathogens when compared to those with shorter fingernail lengths. (IDSA #248.) Environmental contact was an important source of VRE hand colonization in health care workers, but gloves were highly protective. (ICAAC #1334.) Weekly cultures of charts and clipboards of 50 ICU patients with colonization or infection due to VRE, MRSA, or imipenem-resistant P aeruginosa found that one fifth of the patients had a total of 14 positive items, usually discovered at the time of the first culture. (IDSA #798.)
In a Swiss unit using a waterless alcohol compound for handwashing, compliance was 63% in nurses, 59% in physicians, and 49% in other personnel. The number of beds in a patient room was an independent predictor of compliance: 70% for 1 bed, 59% for 2, 55% for 3, 48% for 4, and 33% for 5 bed rooms. (ICAAC #1335.) A study comparing methods of hand hygiene in a surgical ICU found that the use of 62% ethanol gel was superior to the use of either an antimicrobial hand wipe or soap and water in reducing the frequency of hand contamination by potential pathogens. (ICAAC #1337.)
A study of the antifungal activity of handwashing agents against C albicans found that the most effective among those tested was 4% chlorhexidine plus 4% isopropyl-alcohol. One-percent triclosan and 70% ethyl-alcohol were less effective and plain soap was least so. (ICAAC #116.)
Bloodstream Infection. The SCOPE study of nosocomial bloodstream infections in 49 US hospitals found a disproportionately higher incidence in southeastern states. Underlying pulmonary disease, but not neutropenia or admission to an oncology service, was identified as an independent risk factor. (ICAAC #2043.)
A retrospective analysis identified 20 patients with Leuconostoc spp. recovered in culture for an incidence of 19 cases per 100,000 patient admissions; two thirds were nosocomial. Twenty-two isolates were from blood (including 12 with vascular access infection), 6 from peritoneal fluid, and 1 each from urine and synovial fluid. The organism was believed to be definitely pathogenic in 37% (two fifths of whom had septic shock), probably pathogenic in 27%, possibly so in 20%, and nonpathogenic in 16%. (IDSA #235.)
A strain of S capitis with inducible heteroresistance to vancomycin has accounted for approximately one third of all CNS blood- stream isolates since its introduction into a neonatal ICU. (ICAAC #480.)
Three cases of protothecosis in cancer patients were described. Two had pulmonary nodular disease with Prototheca spp. recovered on culture of BAL and improved with fluconazole administration. A third had central venous catheter-related bloodstream infection and responded after catheter removal and administration of amphotericin B. (IDSA #273.)
The incidence of vascular catheter colonization was reduced with the use of chlorhexidine/silver sulfadiazine-impregnated triple lumen catheters when compared to a heparin-bonded catheter in a randomized trial, but there was no difference in the incidence of bloodstream infections. (ICAAC #1426.) In another randomized trial, there was a nonsignificant trend toward reduction in IV catheter-related bloodstream infections in high-risk patients with the use of silver iontophoretic catheters compared to control catheters. (ICAAC #1425.)
One hundred six patients with hematologic malignancies undergoing chemotherapy associated with severe neutropenia were randomized to have venous access established with either a standard triple lumen catheter of one impregnated with chlorhexidine and silver-sulfadiazine. The use of the latter was associated with a significantly reduced incidence of catheter colonization and of IV catheter-related bloodstream infection. (ICAAC #779.)
Nosocomial Pneumonia. High-risk patients requiring mechanical ventilation for more than 2 days were randomized to receive ceftriaxone for 3 days or have continuous aspiration of their subglottic secretions. Ceftriaxone prophylaxis was associated with a significant reduction of the incidence of early onset pneumonia, as well as other infections. (ICAAC #1124.)
Two hundred twenty-one patients with an expected duration of mechanical ventilation > 48 hours were randomized to receive their care in a semi-recumbent position (45º) or supine (10%). In contrast to previous reports, there was no difference in the subsequent incidence of ventilator-associated pneumonia. (ICAAC #1474.)
Antibiotic Resistance. Independent risk factors for nosocomial infection with fluoroquinolone resistant E coli and K pneumoniae were recent fluoroquinolone use, residence in a long-term care facility, recent aminoglycoside use, and older age. (ICAAC #1181.) However, receipt of fluoroquinolone therapy was the only factor protective against isolation of Gram-negative nosocomial pathogens resistant to third-generation cephalosporins in a case-control study. (ICAAC #1182.)
The Environment. A carbapenem-resistant strain of P aeruginosa recovered from 6 MICU patients was identified in the water supply used for hand washing and patient bathing. (ICAAC #476.)
Distal site L pneumophila culture positivity appeared to be more predictive of nosocomial legionellosis than the quantity recovered from individual sites. (IDSA #214.)
An outbreak of MRSA infection in a burn unit and wound care center was believed to be the result of extensive environmental contamination. (IDSA #204.)
Urinary Tract Infection. A prospective sequential study found no benefit from the use of a silver hydrogel urinary catheter, as opposed to a standard catheter, with regard to reduction of the incidence of urinary tract infections. (IDSA #237.)
Antibiotic Use. Seventy six of 157 (48%) vancomycin orders at one hospital were noncompliant with CDC guidelines; after intervention by a "hospital antimicrobial team," the proportion of noncompliant orders was reduced to 16%. (ICAAC #1196.)
Prescribing of antibiotics in ambulatory care settings in the United States declined by approximately 25% between 1992 and 1999. This decrease, however, occurred mostly in physician’s offices, with little change in hospital outpatient or emergency departments. (ICAAC #1864.)
BACTERIAL PATHOGENS AND INFECTION
Gastrointestinal Infection
Epidemiology. Enteroxigenic E coli (ETEC), detected by PCR in 43 of 2900 (1.5%) stool samples at 2 Minnesota laboratories was the third most commonly identified stool pathogen after Campylobacter (81 isolates) and Shigella (67 isolates). There were, in addition, 37 Salmonella and 25 E coli 0157:H7 isolates. Twenty two percent of the cases of ETEC infection were domestically acquired. (ICAAC #766.)
In an illustration that not all foodborne outbreaks of gastrointestinal illness are infectious in origin, contamination of salad contents with the pesticide methomyl caused outbreaks of acute gastroenteritis that mimicked an infectious process. (IDSA #851.) In a possibly more expected occurrence, a self-service food bar was implicated as the source of infection in an outbreak of infection with E coli O157:H7 at an elementary school. It was suggested that self-service was not the safest way to feed young children, given their dicey hygienic practices. (IDSA #299.) The interaction of children with pets and farm animals may also lead to problems. Thus, 28% of 190 children attending a farm day at which they cared for calves developed diarrhea or vomiting. Stool examination revealed C parvum in 11, Shiga toxin-producing E coli in 2, and Salmonella and Campylobacter in 1 each. Multiple pathogens were recovered from 10 calves. (ICAAC #1132.)
"Natural" waters are considered by some consumers to be healthier and safer than tap water. Natural waters are, however, exposed to a natural environment of both flora and fauna. Thus, in one report, well and spring bottled water were identified as potential sources of infection with S bareilly and other amphibian-related Salmonella serotypes. (IDSA #101.)
Staphylococcal food poisoning in 3 family members was caused by a methicillin-resistant strain of S aureus. (IDSA #103.)
Antibiotic Resistance. An alarming increase in antibiotic resistance among Salmonella and Campylobacter isolated from food animals and retail meat was reported. Of 2613 Salmonella isolates obtained in the United States in 1999-2000, 26% were resistant to at least 1 antibiotic and 21% were resistant to 2 or more. These multidrug resistant (MDR) strains accounted for 10% of all Salmonella isolates, 38% of the resistant isolates and 48% of those that were multidrug resistant. A number of the MDR strains, including some identified as Salmonella newport, were resistant to ceftriaxone. (ICAAC #55.) An examination of 184 isolates of this organism in Minnesota from 1994-2000 found that 14% were resistant to at least 1 antibiotic and that 9% were resistant to 5 or more. The prevalence of MDR increased from 2% in 1994-1998 to 33% in 2000. Ceftriaxone resistance, first identified in 1999, was present in 21% of S newport isolates from 1999-2000. (ICAAC #54.)
In some cases, resistance to ceftriaxone may result from beta-lactamase activity. A study in Canada described 8 Salmonella isolates from food animals that contained an AmpC-like enzyme, CMY-2, presented on a readily transferable plasmid that encoded genes for resistance to antibiotics that included ampicillin, cefoxitin, cephalothin, streptomycin, sulfisoxazole, and tetracycline. (ICAAC #56.)
Fifteen percent of 1018 human isolates of C jejuni in the United States were resistant to fluoroquinolones and 3% were resistant to macrolides. Of the 37 patients with fluroquinolone-resistant isolates, 57% had not traveled outside the United States in the 7 days before illness onset. (IDSA #552.) As further evidence that increasing resistance in C jejuni is associated with the use of antibiotics as growth promoters in food animals, it was reported that ciprofloxacin-resistant C jejuni were isolated from chickens given fluoroquinolones after experimental infection with ciprofloxacin-susceptible C jejuni. (ICAAC #LB-2.)
Only 17.9% of Campylobacter isolates from US military personnel in Thailand were susceptible to ciprofloxacin. Other isolated enteric pathogens were susceptible to this flouroquinolone. (IDSA #259.)
C difficile. Community acquisition of toxigenic C difficile infection is being recognized with increasing frequency. C difficile was the most frequently identified enteric pathogen in the Calgary area; one third were identified in stool samples obtained in the outpatient setting. (ICAAC #1232.) C difficile toxin was detected in 2.1% of stool samples from 1000 randomly selected patients presenting with diarrhea to practitioners at 2 distant UK locations. Thirty-nine percent of cases and 77% of controls reported neither recent hospitalization nor recent antibiotic therapy. (ICAAC #768.)
Nonetheless, most C difficile infection is acquired in the inpatient setting, where the organism readily contaminates the environment. A study on 2 geriatric wards found an association between the prevalence of environmental C difficile and staff hand carriage of this organism, but a poor correlation between environmental C difficile and associated clinical disease. Hypochlorite cleaning was more effective in reducing environmental C difficile than was detergent cleaning. (ICAAC #1233.)
Not all patients with C difficile-associated disease present with classical findings of inflammatory diarrhea. Some patients present with ileus and others without prominent gastrointestinal symptoms. In one study, C difficile infection was found to be an important cause of leukocytosis in hospitalized patients. (IDSA #99.) In addition, C difficile may be present without causing disease, especially in infants. In one survey, none of 22 C difficile positive children had evidence of colitis. The authors propose "that diagnostic testing for C difficile be limited to patients with age > 1 year, significant diarrhea for at least 2 days, and other GI symptoms, especially pain." (IDSA #302.)
The presence of disease compatible with C difficile colitis in patients from whom only strains failing to produce either toxin A or toxin B have been isolated has been puzzling. As an example, 24 hospitalized patients developed diarrhea due to indistinguishable isolates of C difficile with a 1.7 kb deletion in the toxin A gene and no toxin A production. (ICAAC #1231.) Analysis of a collection of C difficile isolates of mostly clinical origin found genes encoding binary toxin, an actin-specific ADP-ribosyltransferase, in 4 (8.3%). The investigators state that preliminary data suggest that binary toxin may play a role in diarrhea in patients infected with putatively "non-toxigenic" strains of C difficile. (ICAAC #1236.)
C difficile colitis is a "two-hit" disease—it requires acquisition of the organism from an exogenous source and administration of a selective pressure in the form of an antibiotic. As a result, prevention of this disease requires both effective infection control activities and optimization of antibiotic use. Evidence consistent with the importance of the latter came from the occurrence of a region-wide outbreak of C difficile diarrhea after the elimination of regional antibiotic use programs. (ICAAC #1235.) One possible clue to future means of control came from a study in which the administration of a single oral dose of a nontoxigenic strain of C difficile prevented C difficile-associated disease in hamsters given clindamycin. (IDSA #239.)
H pylori. A randomized trial found that a "test-and-treat" strategy using a serological test for screening of dyspeptic patients reduced the number of endoscopies by 64% as compared to a prompt endoscopy strategy with similar clinical outcomes. (ICAAC #767.)
INTRA-ABDOMINAL AND HEPATOBILIARY INFECTION
Antibiotic Therapy. A meta-analysis of 7 randomized control trials involving 1439 patients with intraabdominal infection found that treatment with piperacillin/tazobactam was superior to treatment with comparator agents with regard to clinical cure or improvement, but did not differ with regard to attributable mortality, bacterial superinfection, or adverse events. (ICAAC #763.)
In a large randomized trial, ertapenem (1 g q.24h.) and piperacillin/tazobactam (3.375 g q.6h.) were equally effective and safe in the treatment of acute pelvic infections in women. (ICAAC #888.)
Prophylaxis in Pancreatitis. Fifty five patients with severe acute pancreatitis were randomized to receive oral gut decontamination with gentamicin, colistin, and amphotericin B, or conventional therapy. Gut decontamination was associated with a significant reduction in subsequent infections, but no difference in mortality. (ICAAC #1455.)
Liver Abscess. A review of 36 episodes of liver abscess in 32 liver transplant recipients found that 75% were associated with hepatic artery thrombosis. Biliary stricture was present in some. Infections were commonly polymicrobial. (IDSA #62.)
Hepatic abscess occurred in 3% of 459 liver transplant recipients at one institution—64% in association with hepatic artery thrombosis and 50% with prior cholangitis. The mean time from hepatic artery thrombosis to diagnosis of liver abscess was 75 days, but in 5 patients, liver abscess was the presenting feature of thrombosis. Gram-negative bacteria were present in 39% of cases, followed by Enterococcus spp. and Staphylococcus spp. (14% each), with anaerobes in 10% and Candida spp. in 7%. (IDSA #63.)
ANAEROBIC BACTERIA
The relative frequency of isolation of nonfragilis Bacteroides spp. has increased significantly over the last 15 years in the United States and they now represent the most commonly recovered anaerobes in intraabdominal infections. This finding has implications in the choice of empiric antibiotic therapy for such infections. (ICAAC #1209.)
Susceptibility testing of anaerobic isolates, including 208 B fragilis and 183 B fragilis group isolates, from 7 Chicago area medical centers, found that the most active agents, with < 1% resistance, were metronidazole, imipenem, ertapenem, piperacillin/tazobactam, and ticarcillin/clavulanate. Clindamycin resistance was seen in 21-50% of B fragilis, 25% of Prevotella spp., 12% of Peptostreptococcus spp., and 5% of Clostridium spp. B distasonis was the most resistant of the B fragilis Group species. (ICAAC #62.)
Analysis of 3045 B fragilis Group isolates from 13 US hospitals that were recovered from 1995-2000 at 13 US hospitals found an overall rate of clindamycin resistance of 22%, but this result varied by anatomic site of isolation. The highest rates of clindamycin resistance (29%) were seen in isolates from decubitus ulcers and abdominal incision wounds. (ICAAC #63.)
Moxifloxacin was highly active against anaerobic and microaerophilic organisms from periodontal infections. (ICAAC #734.) Moxifloxacin resistance in C difficile was associated with prior receipt of older fluoroquinolones. (ICAAC #1234.)
ENTEROCOCCUS
Treatment and Antibiotic Resistance. Resistance to linezolid emerged during therapy in 1 E faecalis and 14 E faecium strains from 15 patients treated with this drug in the context of clinical trials. Risk factors included use of low doses of linezolid, prolonged therapy, an abscess, and infection of an IV catheter. (IDSA #531.) Linezolid-resistant vancomycin-resistant E faecium were recovered from perirectal cultures of 2 of 14 (14.3%) treated with this oxazalidinone antibiotic. (ICAAC #1193.) Resistance to linezolid in E faecium that arose during treatment with this agent was accompanied by reversal of vancomycin resistance in one patient. (IDSA #530.)
A linezolid-resistant E faecium (MIC = 16 mg/mL) was recovered from a patient who had received prolonged therapy with this antibiotic. Despite aggressive infection control measures, the strain was subsequently isolated from 6 additional patients. Sequencing of the organisms’ 23S rDNA detected a G-to-T mutation at position 2576 (E coli numbering); the organisms also carried the van A gene. (ICAAC #IL-3.)
In a case-control study, the factors identified as associated with the development of enterococcal resistance to linezolid were prolonged therapy, underlying malignancy, and exposure to multiple antimicrobials. (ICAAC #1194.)
Twenty patients with endocarditis due to E faecalis, 13 of which were caused by strains with high-level aminoglycoside resistance, were treated with ceftriaxone (2 g q12h in 18) and ampicillin. Six infections involved prosthetic valves. Sixteen of 16 patients who received ceftriaxone for at least 1 month were cured; no microbiological failures and no relapses were detected. (ICAAC #1342.)
Epidemiology of VRE. The prevalence of vancomycin resistance among enterococcal bloodstream isolates increased from 13-15.3% in the United States in the 4 years ending Dec. 31, 2000, in the SENTRY study. (ICAAC #78.)
VRE was present in waste from a pharmaceutical plant manufacturing vancomycin. (ICAAC #517.)
Prior use of impenem or ceftazidime was the strongest predictors of VRE colonization or infection in a large case-control study. No association was seen with the use of piperacillin/tazobactam, gentamicin, or cefazolin. (ICAAC #UL-2.)
VRE was eliminated from stool in 12-of-19 (63%) of patients given fosfomycin and in none of 5 untreated patients (P < 0.05). (ICAAC #1191.)
GRAM-NEGATIVE b-LACTAMASES
Epidemiology. Examination of 1123 K pneumoniae isolates found that ESBL-producing isolates were recovered at 18 of 23 (78%) geographically dispersed US hospitals, while plasmid mediated AmpC b-lactamase producers occurred at 10 (44%) sites. One site had organisms encoding a carbapenemase. (ICAAC #291.) The MYSTIC surveillance program of isolates from across the United States found that, while the prevalence of ESBLs decreased during that time from 5%-3%) for E coli, it increased from 6%-9% for Klebsiella spp. and 0%-3% P mirabilis (PM). (ICAAC #65.)
Of 119 residents of long-term care facilities colonized or infected with an ESBL-producing strain of E coli (also resistant to aminoglycosides and fluoroquinolones), only 23 had acquired the strain during hospitalization in an acute care facility.
pmAmpC. The first instance of an inducible plasmid-mediated AmpC ß-lactamase, ACT-1 in E cloacae was reported. These data are significant because the occurrence of inducible pmAmpC ß-lactamases in Gram-negative pathogens may pose additional challenges in identifying appropriate antibiotic therapy. (ICAAC #1306.) A US isolate of K pneumoniae containing an inducible plasmid mediated AmpC enzyme, DHA-1, was described. (ICAAC #1489.)
Laboratory Identification. Many laboratories use ceftazidime resistance as a screen for possible ESBL production in Enterobacteriaceae. However, 15.8% of putative ESBL containing E coli were susceptible to ceftazidime, but resistant to cefotaxime, while 6.8% of similar K pneumoniae demonstrate this resistance pattern. (ICAAC #185.) Although it is included among the recommended ESBL screens, cefpodoxime resistance may provide false-positive results, with the resistance observed commonly being the result of expression of TEM and AmpC beta-lactamases, often accompanied by OMP changes. (ICAAC #177.)
URINARY TRACT INFECTION
Epidemiology and Prevention. The prevalence of bacteriuria > 105 CFU/mL was 13.5% (7/52) in diabetic women and 18.5% (27/146) in controls. The presence of higher HbA1c levels was associated with a higher risk of bacteriuria in those with type 2 diabetes. (ICAAC #1354.)
Emergence of resistance to fluoroquinolones was not detected during 114 person-years of follow-up in 172 women provided levofloxacin or ofloxacin for self-treatment of 144 recurrent urinary tract infections. (ICAAC #1352.)
A reduction in the number of urinary tract infections was associated with administration of a vaginal mucosal vaccine in a controlled trial in women with recurrent infections. (ICAAC #UL-15.)
Treatment. It has been suggested that trimethoprim-sulfamethoxazole remains an effective choice of empiric antibiotic therapy for uncomplicated urinary tract infections, even when the infecting pathogen proves resistant to this antibiotic combination. However, a study had found that clinical and microbiological cure were each achieved in only approximately one half of 160 patients with urinary tract infections due to trimethoprim/suflamethoxaxole-resistant pathogens given that combination for 5 days. (ICAAC #1350.)
Ertapenem and ceftriaxone were similarly effective in randomized trials of treatment of complicated urinary tract infections. (ICAAC #1053, ICAAC #1056, IDSA #117.)
CENTRAL NERVOUS SYSTEM INFECTION
Epidemiology. There was an annual average of 73,000 hospital admissions for meningitis in the United States from 1988-1997, with approximately one half being viral in etiology, while one fourth were bacterial, 9% fungal, and 19% unspecified. (ICAAC #1589.)
Thirty-two of 261 (12.2%) infants with urinary tract infection who underwent lumbar puncture had evidence of meningitis, but only one had bacterial meningitis. The authors conclude that, while meningitis is relatively common in infants younger than 6 months of age with UTI, it is usually not bacterial in etiology. (IDSA #295.)
Diagnosis. In a prospective cohort study of patients with suspected meningitis, Kernig’s sign, Brudzinski’s sign, and nuchal rigidity were of remarkably low diagnostic value. (IDSA #97.)
Pneumococcal Meningitis. Twenty seven of 49 (55%) S pneumoniae CSF isolates from children were tolerant to penicillin and 2 of these were also vancomycin tolerant. Tolerant and nontolerant strains had similar rates of penicillin nonsusceptibility (40% vs 37%). Penicillin tolerance did not appear to affect the outcome of therapy. (IDSA #120.)
Both moxifloxacin and BMS-284756 were as effective as vancomycin plus ceftriaxone in the treatment of experimental meningitis in rabbits due to vancomycin-tolerant strains of S pneumoniae. (ICAAC #1861.) Ertapenem was efficacious against PenS and PenR pneumococci in a rabbit model of meningitis, using a dose that approximates 500 mg iv in humans. (ICAAC #1860.)
A cognitive disorder, primarily loss of cognitive speed, was found in approximately one fourth of adults with apparent good recovery from pneumococcal meningitis. In contrast, this was the case in only 4% of adults who recovered from meningococcal meningitis. (ICAAC #1975.)
Meningococcal Meningitis. Fifty eight adults with meningococcal meningitis (44 confirmed, 14 probable) were treated with 2 million units benzyl penicillin intravenously every 4 hours for a median of only 3 days (range, 1-5 days). There were 5 deaths (8.6%)—3 within 24 hours of admission, 1 on day 3, and 1 on day 15—due to multiorgan system failure. There were no relapses. (IDSA #119.)
Ommay Reservoir Infection. A retrospective analysis of 29 CSF Ommaya reservoir infections led the authors to conclude that the reservoir need not be removed unless the patient is unstable or the culture positivity persists. Administration of antibiotics via the catheter was safe and may have improved outcomes. (IDSA #118.)
Amebic Encephalitis. Two patients with amebic encephalitis, one due to Acanthamoeba castellani and the other unknown, died despite aggressive attempts at therapy, as did 3 children with Balamuthia mandrillaris infection. (IDSA #265, IDSA #266, IDSA #267.)
PHARYNGITIS, OTITIS, SINUSITIS
The most frequently identified pathogens in 127 children with pharyngitis were adenovirus (35.9%), RSV (29.1%), S pyogenes (25.2%), M pneumoniae (24.2%), and C pneumoniae (21.3%). (ICAAC #1536.)
In a randomized trial involving 373 children with otitis media, azithromycin given for 3 days and Augmentin given for 10 days were equally effective. (ICAAC #1532.)
In a double-blind, randomized trial involving 445 adults with acute maxillary sinusitis, the efficacies of gatifloxacin given for 5 days and amoxicillin/clavulanate given for 10 days were equivalent. (ICAAC #907.) Telithromycin given for 5 days was as effective as comparator agents (amoxicillin/clavulanate and cefuroxime axetil) given for 10 days in the treatment of acute maxillary sinusitis in randomized trials. (ICAAC #909, ICAAC #910.) Treatment of acute bacterial maxillary sinusitis for 5 days with cefpodoxime was as effective as 10 days of therapy with this agent. (ICAAC #916.)
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